POS1167 SHORT-TERM OUTCOME OF ADULTS WITH IGA VASCULITIS – A SINGLE CENTER EXPERIENCE
Authors: A. Hočevar, J. Ostrovrsnik, M. Tomsic, Z. Rotar
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Follow-up data on IgA vasculitis (IgAV) in adults are scarce compared to paediatric population. <h3>Objectives</h3> The aim of our study was to investigate the short-term outcome in a well-defined adult IgAV cohort. <h3>Methods</h3> We analyzed medical records of histologically proven adult IgAV cases diagnosed between January 2010 and July 2022, and followed at our rheumatology center for more than 3 months. The frequency and type of relapses were studied. In addition the information on renal function (creatinine, estimated glomerular filtration rate (eGFR)) and urine analysis was recorded. Persistent abnormal urinalysis was defined as persistent haematuria (&gt;10x10<sup>6</sup> red blood cells/L) and/or daily proteinuria &gt;300 mg. A significant worsening of renal function during follow-up was defined as eGFR decline &gt;20% from baseline. Risk factors for relapsing IgAV and persistent abnormal urinalysis were studied using Cox regression analysis. <h3>Results</h3> We identified 362 IgAV patients (59.4% males, median (IQR) age 64.2 (45.4; 76.2) years). Four patients died during the acute IgAV. Of the remaining patients, 265 (73.2%) were followed for a median (IQR; range) 24.1 (12.5, 55.2; range 3.0 to 146.1) months, while 93 patients had either a follow-up time less than 3 months or were lost to follow up. Of 265 patients 38.9%, 29.8% and 44.5% had at baseline articular, gastrointestinal, and renal involvement, respectively; and 28.3% had skin limited IgAV. One hundred and eighty-nine (71.3%) patients received at baseline systemic glucocorticoid, and 32 (12.1%) additional immunomodulatory therapy. One patient transiently required haemodialysis. During the follow-up period 42 (15.8%) patients relapsed. Table 1 shows the frequency and type of relapses. As factors associated with relapses emerged age (HR 0.97 (95% CI 0.95; 0.99)), and the use of systemic glucocorticoid at initial presentation (HR 0.27 (95% CI 0.15; 0.50)). Seventy-four (27.9%) patients had persistent abnormal urinalysis during follow-up, and 12 (16.2%) of them had daily proteinuria &gt;1g. As factors associated with persistent abnormal urinalysis emerged heart failure as comorbidity (HR 2.28 (95% CI 1.20; 4.32), articular involvement (HR 0.42 (95% CI 0.25; 0.70)) and baseline immunomodulatory treatment (HR 2.30 (95%CI 1.29; 4.10)). eGFR decline of &gt;20% from baseline was recorded in 41 (15.5%) patients (in 18/74 (24.3%) patients with persistent abnormal urinalysis, and in 23/191 (12.0%) patients without clear IgAV associated renal pathology; p=0.022). Heart failure (HR 3.06 (95%CI 1.44; 6.52)) and age (HR 1.03 (95CI 1.01; 1.05)) were associated with eGFR decline during follow up. Two patients developed end-stage kidney disease in association with IgAV. Forty-eight (18.1%) patients died during follow-up period, and death of one patient was related to IgAV relapse. <h3>Conclusion</h3> Fifteen percent of our adults had relapsing IgAV course, with skin relapses being the predominant relapse type. Younger patients with symptomatically managed IgAV were more prone to relapse. Persistent abnormal urinalysis was recorded in a quarter of patients. Concurrent heart failure had an impact on the persistent renal pathology in adult IgAV. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.